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WhenIt's More ThanBack PainJan2015

Chronic pain in the lower back can be more significant than you realise. Learn about spondyloarthropathy and how to spot the signs.

Spondyloarthropathy causes back pain, joint pain and inflammation, and can be mistaken for other types of pain. This is because awareness of this autoimmune disease tends to be low. And because the condition affects younger people, many downplay and manage the symptoms until the condition worsens.

In spondyloarthropathy, the immune system gets confused and attacks the body. The term refers to a family of long-term diseases of the joints that include ankylosing spondylitis, Reiter's syndrome (reactive arthritis), psoriatic arthritis, and joint problems linked to inflammatory bowel disease (enteropathic arthritis). While each of these specific conditions present different symptoms and outcomes, they are similar in that all of them:

usually involve the sacroiliac joint in the lower back, causing pain in the buttocks area

affect areas where your ligaments and tendons attach to bone, most commonly causing pain in the heel

involve stiffness in the back or neck that is worse in the morning and after periods of rest but gets better during the day and after exercise

cause fatigue

Types of Spondyloarthropathles

Ankylosing Spondylitis causes stiffness and lower back pain. In severe cases, the affected joints in the spine fuse together. In children, the signs start in the hips, knees, heels or big toes, and progress to the spine. Other areas such as the chest wall and heels may also be affected.

Reiter's Syndrome causes pain, swelling and inflammation of the joints after infections, especially sexually transmitted diseases. The fingers and toes may swell, and fever, weight loss, skin rash, mouth ulcers and inflammation of the eyes can also occur.

Psoriatic Arthritis is a type of arthritis associated with psoriasis (scaly red patches on the skin). This rash precedes the arthritis symptoms, sometimes by years. Fingernails and toenails may also become thickened and yellow. Psoriatic arthritis involves both small and large joints, such as the fingers, toes, knees, hips and sacroiliac joints (tailbone).

Enteropathic Arthritis is spinal arthritis that also involves inflammation of the intestinal wall. The arthritis affects large joints such as the knees, hips, ankles, and elbows.

Treatment

Short-term medicine includes painkillers to reduce swelling and pain. It is more important to consider disease-modifying medication which controls the immune system, such as sulfasalazine and methotrexate. In recent times, research has shown a role for the newer biologic disease-modifying drugs such as anti-tumour necrosis factor agents that are now approved for use in several countries. They have been shown to be highly effective in treating not only arthritis of the joints but spinal arthritis associated with ankylosing spondylitis and related diseases. This class of drug attempts to block a protein that causes inflammation.

Spondyloarthropathy or Rheumatoid Arthritis?

While both cause joint pain and swelling, the pattern of joints affected is different. Spondyloarthropathy also has a different diagnostic marker. It is associated with the presence of the HLA-827 gene, while rheumatoid arthritis is linked to a different marker. Spondyloarthropathy tends to affect more men, while rheumatoid arthritis affects more women.

About Our Arthritis Specialist

A/Prof Leong Keng Hong is a senior consultant Rheumatologist at Gleneagles Medical Centre and Adjunct Associate Professor, Yong Yoo Lin School of Medicine, National University of Singapore. He founded the Osteoporosis Society (Singapore) in 1996 and served as its President until 2004. He was also the Inaugural Chairman of the Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore from 2004-2007 and its current Chairman until 2013.

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